Abstract Aims: Recurrent pregnancy loss (RPL) is usually defined by two or more consecutive clinical miscarriages, which causes psychological trauma for couples. In this study, we aimed to investigate the predictive role of Fibrinogen to albumin ratio (FAR) in patients with RPL. Methods: Pregnant women in their first trimester of pregnancy were included in the study and divided in to two groups as RPL patients (n:44) and patients with no previous recurrent miscarriage (n:60) as control group. Demographical parameters and routine blood parameters (fibrinogen, D-dimer, fibrinogen to albumin ratio (FAR), neutrophil to lymphocyte ratio (NLR), platelet count, main platelet volume (MPV), and red cell distribution width (RDW) values) were compared between the RPL group and the control group. Results: The groups were determined to be statistically different in regards to gravidity and parity (p<0.05). The difference between the groups was statistically different in regards to fibrinogen (mg/dl), albumin (g/dl), FAR (%), NLR (%), RDW-coefficient of variation (CV) (%), RDW-standard deviation (SD) (fL), and platelet counts (10-3/ uL). However, MPV (fL) and D-dimer (ug/L) levels were similar in both groups. The receiver operating characteristic (ROC) curve analysis revealed that the NLR levels were 84.1% sensitive and 75% specific with a cut-off value of 4.27 and the FAR levels were 79.5% sensitive and 88.3% specific with a cut-off value of 105.69 for predicting RPL. Conclusion: Our results indicate that the FAR and NLR levels seem to be effective parameters for predicting RPL with high sensitivity and specificity.

Introduction: In this study, it is planned to compare the RT-PCR test, which is the gold standard in the diagnosis of COVID-19, with Thorax computed tomography (CT) and rapid antibody test results. Methods: Patients who were admitted to the emergency service of İzmir Çiğli Training and Research Hospital between 01.04.2020 and 31.05.2020 and who were suspected of having COVID-19 infection were included in the study. The medical records of the patients were retrospectively analyzed through the hospital data processing database. Age, gender, hospitalization, status of home quarantine, real-time reverse transcription-polymerase chain reaction (RT-PCR), thorax CT and rapid antibody test results of the patients were examined. The relationship between RT-PCR, thorax CT and rapid antibody test results were compared statistically. Results: A total of 181 patients, 115 (63.5%) male and 66 (36.5%) female, with an average age of 56.4 ± 18.06 years were included in the study. The nasopharyngeal swab PCR result obtained at the first admission of the patients to the emergency department was positive in 71 (39.2%) patients. Thorax CT was performed in 173 (95.6%) patients who applied to the emergency department, and 112 (64.7%) of them had findings that could be compatible with COVID-19. According to the thorax CT findings in patients, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting COVID-19 infection were respectively; 76.1%, 43.1%, 48.2% and 72.1% (ĸ: 0.176, p <0.001). In our study, the mortality rate for COVID-19 was found to be 2.8%. Conclusion: Rapid antibody test and thorax CT examinations were found to have low diagnostic value in patients who admitted to the emergency department of our hospital and whose first RT-PCR SARS-CoV-2 test was positive. Studies involving larger patient groups are needed for their use alone in diagnosis and screening.

Background and aim: Peptic ulcer is considered an important public health problem and generally associated with complicated conditions such as bleeding and perforation. The aim of this study is to reflect the rate of oxidative damage in the body among patients with H. pylori positive peptic ulcer by measuring serum 8-hydroxy-2p-deoxyguanosine (8-OHdG) and its association with the level of bacterial endotoxin. Methods Patients applied to Harran University Gastroenterology Outpatient Clinic with dyspeptic complaints were enrolled in this study. According to gastrointestinal endoscopy findings, 43 patients with H.pylori positive peptiv ulcer patients and 43 healthy volunteers were included in this study. H.pylori diagnosis was detemined by H.pylori urea breath and stool antigen tests. Serum 8-OHdG and endotoxins were measued by ELISA. Results A total of 43 patients with peptic ulcer (13 females 30 males), 43 healthy individuals (16 females 27 males) ages (18- 70) years in the study. In biopsies taken endoscopically; Hp severity was mild in 19 patients (43.9%), moderate in 21 patients (48.5%), and severe in 3 patients (7.6%). 8-OHdG which has the potential to mark DNA damage level in serum samples of patients with H.pylori positive peptic ulcer, was compared with the healthy and patient group. It was observed that there was a statistically significant difference (p <0.01). In addition, a weak correlation was found between OHdG and endotoxin. Conclusion: Reactive oxygen species (ROS) produced due to increased endotoxin as a result of H. pylıori infection can attack nucleic acid in infected cells resulting in an increased in serum 8-OHdG level. H.pylori and its endotoxin had a significant in peptic ulcer pathogensis.

Background: Chronic Obstructive Pulmonary Disease (COPD) which is characterized by persistent airflow restriction and respiratory symptoms. Studies demonstrated that cardiac arrhythmias, cardiovascular mortality and cardiac death increased in these patients due to altered myocardial repolarization. Frontal QRS-T angle is a novel marker of myocardial depolarization and repolarization heterogeneity. In this study, we aimed to investigate the relationship between frontal QRS-T angle and COPD severity in patients with newly diagnosed COPD. Methods: A total of 104 newly diagnosed COPD patients without any significant comorbidities were included in this study. Patients were divided into two groups according to GOLD stage as follows: patients with mild and moderate COPD (group I) and severe and very severe COPD (group II). Frontal QRS-T angle was calculated from the automatic report of the electrocardiography device . Results: Frontal QRS-T angle was significantly higher in group II patients compared to in group I patients (43.0 [25.5-60.0] vs. 20.0 [12.0-32.0], P < 0.001). The best cut-off value of frontal QRS-T angle for predicting severe-very severe COPD was ≥ 34.5°. Correlation analysis showed that frontal QRS-T angle was negatively correlated with FEV1/FVC (r = –0.524, P < 0.001) and MEF25-75 (r = –0.453, P < 0.001). In linear regression analysis, It was found that MEF25-75 (β: –0.593, P = 0.006) was the only independent predictor of the frontal QRS-T angle. Conclusions: Frontal QRS-T angle, an easily obtainable marker form surface electrocardiography. In this study, we have shown for the first time that frontal QRS-T angle was significantly increased in patients with severe and very severe COPD.

Background: Cystic echinococcosis (CE) is commonly located in the liver and lungs of affected hosts. Surgical management is one of the best choices for the treatment of hydatidosis and using effective scolicidal agents during hydatid surgery is essential to prevent secondary infection. The present study was designed to investigate the in vitro scolicidal activity of methanol extract of Sideritis perfoliata against the protoscoleces of hydatid cysts. Methods: The protoscoleces were collected from slaughtered livestock in Adiyaman and the effect of three concentrations of the aerial part extract of S. perfoliata (0.1mg/ml, 0.2mg/ml, and 0.4mg/ml) was assessed over three different exposure periods. All tests were carried in dublicate. Finally, the mortality of protoscoleces was assessed by the eosin exclusion test (0.1% eosin staining). Methanol extract of S. perfoliata was assessed by Liquid Chromatography-Mass Spectrometry/Mass Spectrometry (LC-MS/MS). Results: The results showed that the scolicidal effect of this extract at exposure periods of 10, 20, and 30 min was 29.6, 32.5, and 43.6% at concentrations of 0.1mg/ml, 37.8, 50, and 58.1% at concentration of 0.2mg/ml and finally 57.9, 71.8, and 79.1% at concentration of 0.4mg/ml, respectively; indicating that the extract requiring a further time to display a potent protoscolicidal effects. Some phenolic acids such as fumaric acid (260,13mg/L), syringic acid (27,92mg/L) and caffeic acid (26,84mg/L) and a flavonoid, luteolin (11,23 mg/L) were detected in high concentrations. Conclusions: The present study has demonstrated that the methanol extract of S. perfoliata has high scolicidal power in vitro, although the low concentration of plant extract may provide a base for future treatment of hydatid cysts. However, more research on the in vivo efficacy of S. perfoliata extract and its potential side effects is recommended.

Background: There is a great need to make a rapid differential clinical diagnosis of COVID-19 among respiratory disease patients and determining the prevalence rate of these diseases among the COVID-19 population. Method: Approximately 522 patients with allergic rhinitis, asthma, COPD, and COVID-19 were analyzed for demographic and clinical features. Radiological features were analyzed only for COVID-19 patients. Results: COPD and asthma were more common among COVID-19 patients than allergic rhinitis. All chest CT scans of COVID-19 patients showed bilateral ground-glass opacity. Fever, dry cough, diarrhea, loss of sense of smell and taste, shortness of breath, and blue lips were significantly higher in all COVID-19 patients compared to COPD, asthma, and allergic rhinitis patients. Conclusion: The presence of clinical symptoms such as fever, dry cough, diarrhea, loss of sense of smell and taste, shortness of breath, and blue lips in COVID-19 patients, can be used for differential diagnosis between COVID-19 patients and other respiratory diseases. Then, the diagnosis can be confirmed by chest CT scan for COVID-19 patients without the need for a nasopharyngeal swab or PCR test, especially in epidemic countries. Allergic rhinitis patients are the least exposed to COVID-19 infection among other respiratory disease patients.

Introduction: As COVID-19 disease has rapidly spread across the world, its impact has grown with increasing number of cases and mortality rate in Turkey. Aim: The aim of this study is to examine epidemiologic and clinical features of the patients that admitted to the hospital with the pre-diagnosis of coronavirus disease-2019 (COVID-19) in Turkey. Method: In this retrospective study, epidemiologic and clinical features, laboratory findings, radiologic features, therapeutic approaches and survival conditions of the patients with the pre-diagnosis of COVID-19 from March 11th to June 30th, 2020. The all data of the cases were compared in 4 groups: 1st group for the confirmed cases reverse transcriptase polymerase chain reaction (RT-PCR) +, chest computed tomography (CT) +, 2nd group for the clinically diagnosed cases (RT-PCR- CT +), 3rd group for the mild and asymptomatic cases (RT-PCR + CT-), 4th group for the suspected cases (RT-PCR - CT -). Post-hoc analysis was performed to evaluate the differences among the groups. Results: In total, 3334 patients with the pre-diagnosis of COVID-19 admitted to the emergency department. Based on the post-hoc analyses, significant differences were found among the four groups in terms of their test results of leucocytes, hemoglobin, platelets, neutrophils, urea and C-reactive protein (CRP) (p<0.001). Furthermore, the factors of age groups, hospitalization, intensive care follow-up and mortality rate of the four groups showed a significant difference among the groups (p=0.001). Conclusion: Mean of leucocytes, neutrophile and platelet values of the patients with tested positive for the RT-PCR was found lower compared to the ones with tested negative for the RT-PCR. Mean of CRP values was found higher in patients with lung involvement compared to other patient groups.

Objective:After radical prostatectomy,prostate-specific antigen(PSA) value measuring ≥0.1ng/ml is defined as persistent PSA(pPSA) and in many studies,it was found to be associated with aggressive disease and poor prognosis.Our aim in this study is to point out the pathological and clinical factors affecting pPSA among the patients who underwent robot-assisted radical prostatectomy(RARP) in an experienced academic center and to make a nomogram,predicting pPSA value based on operative data,useful. Methods:We examined records of 1273 patients who underwent RARP retrospectively. Preoperative,operative,and postoperative data were collected.Based on the PSA values (ng/ml) measured after 4-to-8 weeks of RARP,patients were divided into 2 groups as pPSA group (Group1)(n=97) with PSA values ≥0.1ng/ml and undetectable PSA group (Group2)(n=778) with PSA values <0.1ng/ml.Later on,Group1 was further divided into Group1a (PSA:0.1-0.2ng/ml) and Group 1b (PSA≥0.2ng/ml) to evaluate biochemical recurrence(BCR). Results:Multivariate logistic regression analyses of the collected data revealed that PSA>20ng/ml,operation time,a postoperative international society of urological pathology (ISUP) grade of ≥4, pT 3-4, and pN were independently associated with pPSA.According to the results, a nomogram predicting pPSA was developed(Table 4).By looking at the nomogram pPSA was found in 98.9% of the cases with a PSA value of ≥20ng/ml, an operation time of 150 minutes, a postoperative ISUP grade of 4-5, a positive lymphovascular invasion (LVI) status, pT3-T4, and pN+; while pPSA was found in 25.5% of the cases with a PSA value of <20 ng/ml, an operation time of 100 minutes, a postoperative ISUP grade of <4-5, a negative LVI status, pT<3-4, and pN-.The estimated BCR-free survival time was 16.3 months in Group 1a and 57.0 months in Group2 (p<0.001).Adjuvant treatment ratio was 64.9% in Group1 and 7.1% in Group2 (p<0.001). Conclusion:For the patients who underwent RARP,factors associated with aggressive disease can predict the PSA persistence.To plan our treatment modalities accurately,an applicable nomogram in daily practice would be useful.

Introduction The dissection of perirenal fat is of critical importance to kidney surgery and ease of dissection is more important when using minimally invasive approaches. This study aimed to determine the clinical, radiological, and pathological significance of adherent perirenal fat(APF). Materials and Methods This prospective study included 22 patients scheduled for partial nephrectomy and 40 patients for donor nephrectomy. Intra-operative fat dissection time was recorded and the complexity of perirenal fat dissection was surgeon-classified as easy, moderate, and difficult. Perirenal fat and subcutaneous fat thickness was measured. Measurement of perirenal fat depth, and the Hounsfield unit(HU) for both perirenal and subcutaneous fields was performed using CT images. All specimens were submitted for histopatological analysis. Researchers in each arm were blinded to other researchers’ data. Results Mean age of the patients was 51.3±12.7years. Mean perirenal fat dissection time was 15.0±13.5min. Patient demographics, BMI, nor occupational status differed between the 3 complexity of perirenal fat dissection groups. Radiological findings showed that there was a significant correlation between perirenal fat depth and complexity of perirenal fat dissection(p<0.05), but not with HU measurements or subcutaneous fat thickness. Surgeon classification of the complexity of perirenal fat dissection was in accordance with the duration of dissection(p<0.05). Perinephric fat contained more fibrous tissue in the patients with histologically proven APF than in those without(p<0.05). Conclusions APF is a challenge during kidney surgery. Difficult dissection prolongs the duration of surgery, which can lead to complications. Perirenal fat thickness measured via pre-operative CT might be used to predict APF.

Abstract Objective The aim of this study is to examine the effectiveness of a single physician-led weight loss program in a primary care. Methods This is a retrospective analysis of 300 patients with a BMI >30 kg/m2 in an outpatient weight loss program. Weight loss interventions included lifestyle counseling and pharmacotherapy. Outcomes were assessed based on percentage weight change during a time period of two consecutive visits less than 90 days. Results We found that 57.7%, 43.3% and 16.1% patients who attended the clinic 5 or more times, 4-5 times, 2-3 times respectively achieved 5% weight loss (p < 0.0001). In regard to achieving 10% weight loss, 42.3%, 8.7% and 4.3% patients who attended the clinic 5 or more times, 4-5 times and 2-3 times did it respectively (p<0.0001). Moreover 60% of patients achieved 5% of weight loss in about 200 days, and 40% achieved 10% weight loss in 350 days. Patients who achieved 5% weight loss, their average A1c was reduced to 5.8 at their last visit from 6.4 at the first visit. Conclusions A single physician-led weight loss program is effective and can be created within a primary care setting to achieve 5-10% weight loss.

Background: Cardiac arrests (CA) are a leading global cause of mortality. The American Heart Association (AHA) promotes several important strategies associated with improved cardiac arrest outcomes, including decreasing pulse check time and maintaining a chest compression fraction (CCF) > 0.80. Video review is a potential tool to improve skills and analyze deficiencies in various situations, however its use in improving medical resuscitation remains poorly studied in the emergency department (ED). We implemented a quality improvement initiative, which utilized video review of cardiac arrest resuscitations in an effort to improve compliance with such AHA quality metrics. Methods: A cardiopulmonary resuscitation Video Review Team (CoVeRT) of emergency medicine residents were assembled to analyze CA resuscitations in our urban academic ED. Videos were reviewed by two residents, one of whom was a senior resident (PGY-3 or -4), and analyzed for numerous quality improvement metrics, including pulse check time, CCF, time to intravenous access, and time to patient attached to monitor. Results: We collected data on 94 cardiac arrest resuscitations between July 2017 and June 2020. Average pulse check time was 13.09 (SD ±5.97) seconds, and 38% of pulse checks were less than 10 seconds. After the implementation of the video review process, there was a significant decrease in average pulse check time (p=0.01) and a significant increase in CCF (p=0.01) throughout the study period. Conclusions: Our study suggests that the video review and feedback process was significantly associated with improvements in AHA quality metrics for resuscitation in CA among patients presented to the ED.

Background: CRC incidence is increasing in our region. There is no specific CRC control program or national cancer registry in Pakistan. Previously no data has been published on presentation and diagnosis delay of CRC in our region. This study is conducted to determine the factor affecting delay in presentation and diagnosis and to provide baseline information to launch a CRC control program. Primary objective is to determine factor causing delay in diagnosis of CRC. Secondary objective is to evaluate relationship between tumor site and stage of CRC with presenting symptoms and symptom duration. Methods: This project is a prospective cross-sectional study on 113 biopsy-proven CRC patients admitted to the surgical ward of civil hospital Karachi. Results: A total number of participants was 113. Presentation delay was observed in 83.2% of patients. The main reasons for a reported delay in the presentation were lack of patients’ knowledge that these symptoms may be cancer (60.4%), the wrong diagnosis by the primary physician (34.6%), or the patient didn’t want to visit the doctor (0.04%). Most tumors (95%) originated from the sigmoid and rectum. 38.9% and 44.2% of the patients diagnosed at Stage 4 and 3 respectively. Conclusions: This study revealed that CRC patients in Pakistan are facing delays in presentation and diagnosis. This is the reason behind diagnosis at the advanced stage with a poor prognosis. Based on this study findings CRC control program should be introduced to detect CRC at an early stage. Keywords: Colorectal cancer, Colon, Rectum, Cancer, Presentation delay, Diagnosis delay.

Background and objectives Breast cancer is one of the most common malignant tumors in women. Herein, we compared the analgesic efficacy of ultrasound-guided rhomboid intercostal nerve block , erector spinae plane block and serratus plane block after modified radical mastectomy of unilateral breast cancer. Methods: A total of 90 patients who underwent modified radical mastectomy for unilateral breast cancer were selected. patients were randomly allocated into three groups receiving ultrasound-guided serratus plane block, erector spinae plane block, and the rhomboid intercostal block group. All groups received 20 mL 0.5% ropivacaine. Within 24 hours after operation, the patient received intravenous injection of tramadol 1-2 mg/kg to relieve pain in the surgical ward. Results: The dosage of tramadol 24-hours postoperatively in the rhomboid intercostal block and erector spinae plane block groups was significantly lower than that in serratus plane block group (P < 0.001). There was no statistical difference in tramadol consumption between the erector spinae plane block and rhomboid intercostal block groups within 24 hours (P = 0.676). The numerical rating scale scores in the erector spinae plane block and rhomboid intercostal block groups at 0.5, 1, 3, 6, 12, 18, and 24 hours postoperatively once patients were active were significantly lower than in the serratus plane block group (P < 0.05 for all comparisons); however, The numerical rating scale scores between rhomboid intercostal block and erector spinae plane block groups did not differ significatively within 24 hours after surgery when patients were active. Conclusions: Ultrasound-guided rhomboid intercostal block and erector spinae plane block can reduce the dosage of tramadol and NRS score compared with serratus plane block after modified radical mastectomy.

Background: To evaluate the efficiency and safety of medium power (MP) holmium laser devices in the enucleation of the enlarged prostate (HoLEP) adenomas compared to high power (HP) laser devices. Methods: Based on the device power used, a total of 120 patients were divided randomly into two groups. While patients in Group 1 were treated with a MP device (50 W) at 39.6-W (2.2J / 18Hz ), patients in Group 2 were treated with HP (100W) device at 42W (1.2J / 35Hz). Peri- and postoperative parameters were well evaluated in both groups with an emphasis on enucleation efficiency and hemoglobin decrease in a comparative manner. Results: Peri- and postoperative parameters as well as functional results were similar in the two groups. The median enucleation efficiency (EE) values in Group 1 and Group 2 were 1.15 (IQR: 0.33-2.2) and 1.11 (IQR: 0.4-2.8), respectively (p=0.775). Hemoglobin decrease values in Group 1 and Group 2 were 1.3 (IQR: 0.1-4) and 1.4 (IQR: 0.4-3.1), respectively (p=0.736). Significant improve in the postoperative functional parameters were noted again in both groups. Conclusion: Our results indicate well that similar to the HP laser devices, effective and safe removal of the enlarged prostate adenomas with MP laser devices (50W) is possible without any technical difficulties, even in patients receiving antithrombotic therapy.

Background Among respiratory diseases, asthma is one of the most burdensome disorder worldwide. Growing evidence disclose gut dysbiosis may contribute to asthma via the gut-lung axis. Constipation can lead to alteration of the gut microflora. The clinical impact of constipation on asthma has not been researched. Therefore, we aim to assess the risk of asthma in constipated patients by a nationwide population-based cohort study. Methods We analyzed 82421 constipated patients and 82421 individuals without constipation between 1999 and 2013 from the Taiwanese National Health Insurance Research Database. Analysis of propensity score was utilized to match age, gender, comorbidities, and medications at a ratio of 1:1. Besides, multiple Cox regression analysis was performed to evaluate the adjusted hazard ratio of asthma. Furthermore, sensitivity tests and a stratified analysis were conducted. Results The incidence of asthma was 10.8 per 1,000 person-years in the constipation group, which was higher than the rate of 5.6 per 1,000 person-years observed in the non-constipation group. After adjustment for age, gender, comorbidities, and medications, constipated patients had a 1.91-fold greater risk of asthma compared to those without constipation (adjusted hazard ratio [aHR]: 1.91 (95% C.I. 1.84-1.99). In subgroup analyses, patients aged 20-39 years had a 2.04-fold highest risk of asthma in the constipation cohort (aHR:2.04, 95% CI, 1.84-2.26). Besides, the severity of constipation is associated with an increased risk of asthma; the aHR was 1.76 (1.69-1.85), 2.15(2.03-2.27), and 2.29(2.10-2.49) for < 3 times, 3-12 times, and ≥12 times of laxatives prescription within one year, respectively. (p<0.001) Moreover, constipated patients had a higher likelihood of asthma, regardless of gender, comorbidities, and medications. Conclusion Constipation relates to a significantly increased risk of asthma. Physicians should be aware of the possibility of asthma in constipated people. Further research is warranted to investigate the possible pathological mechanisms of this association.

Introduction: Human Immunodeficiency virus is a chronic infection that attacks the immune system of the human body, particularly CD4 T lymphocytes. Combined antiretroviral therapies are highly effective in virological suppression of human immunodeficiency virus infection. It has been shown that some retroviral therapies have a higher nephrotoxicity potential. As a result of renal injury, serum creatinine increases, and the estimated glomerular filtration rate is reduced. The aim of our study was to assess changes in kidney function during a 24-month period in HIV-positive patients who were begun on combined antiretroviral therapy. Material-method: A total of 127 HIV positive patients were enrolled. The patients were divided into five groups; patients who received no therapy were designated as Group 1; those that received Dolutegravir/Abacavir/Lamivudine combination as Group 2; those that received Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Fumarate combination as Group 3; those that received Emtricitabine/Tenofovir Disoproxil Fumarate/Dolutegravir combination as Group 4; and those that received Emtricitabine/Tenofovir Disoproxil Fumarate/Raltegravir combination as Group 5. We compared the effects of these drugs on estimated glomerular filtration rate during a 24-month follow-up period. Results: At the 24th month of therapy, a significant difference was observed between the eGFR levels of the study groups (p:<0.001). eGFR level was significantly higher in Group 4 compared to Groups 1, 2, and 3 (p:0.009, p:<0.001, p:<0.001, respectively) while it was significantly lower in Group 5 than groups 1, 2, and 3 (p:0.005, p:<0.001, p:<0.001, respectively). No significant eGFR difference was found between Group 4 and Group 5 (p>0.05). Serum creatinine level was significantly higher in Groups 4 and 5 compared to the other groups (p<0.001). Conclusion: The use of TDF-containing regimens causes renal dysfunction. Therefore, we recommend close monitoring of renal function, especially in patients treated with TDF.

Background: Helicobacter pylori (H. pylori) is the most common cause of gastric cancer. Growing evidence suggests that the regular arrangement of collecting venules (RAC) can be used as an endoscopic marker to diagnose H. pylori infection. However, data on the diagnostic accuracy of RAC for H. pylori infection are conflicting. We performed a systematic review and meta-analysis of relevant studies to determine the diagnostic accuracy and clinical utility of RAC for the diagnosis of H. pylori infection. Methods: We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library between inception and Oct 29, 2020, for studies that assessed the diagnostic accuracy of RAC for H. pylori infection. Results: The literature search yielded 2921 nonduplicated screened titles, of which 58 underwent full-text review. Fifteen studies, representing a total of 6621 patients, met the inclusion criteria. The area under the summary receiver operating characteristic curve was 0.98 (95% CI 0.96 to 0.99). The pooled estimates for RAC were 0.98 (95% CI 0.95 to 0.99) for sensitivity and 0.75 (95% CI 0.54 to 0.88) for specificity. The pooled positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 3.8 (95% CI 1.9 to 7.7) and 0.03 (95% CI 0.02 to 0.07), respectively. Conclusions: RAC can be used as an endoscopic marker for exclusion of H. pylori infection. However, it cannot be recommended as a single indicator for the confirmation of H. pylori infection. The conclusion of this study should be treated with caution because significant heterogeneity exists between the evaluated studies.

Introduction: In dermoscopic studies on dermatofibromas, some publications divide the appearance of lesions into standardized patterns, and some publications classify the clinical appearance of the lesions by comparing them with existing dermatological lesions. Objectives: This study aims to re-evaluate the dermoscopic findings and patterns of dermatofibromas from a different perspective. Methods: In this study, 142 lesions of 72 patients were evaluated dermoscopically and their patterns were schematized. Results: In our study, a total of 15 patterns consisting of main and sub-patterns were created. The most common patterns we detected were pattern 1 (1a: 13.4%, 1b: 8.5%), pattern 8 (8a: 10.6%, 8b: 4.2%), pattern 2 (2a: 9.2%, 2b: 4.2%), respectively. Conclusions: Patterns of DFs were reclassified while preserving basic patterns. We think that the new sub-patterns and schematization with this study can contribute to better understanding of DFs.